AMED to work with fire company EMRs

William Kibler

Staff Writer

bkibler@altoonamirror.com

Call it the Watters Workaround.

AMED Executive Director Gary Watters has persuaded the state Department of Health to accept a setup that will allow small, rural fire companies to resume Quick Response Services that many have dropped recently due to tightened regulations.

The workaround could save lives, said AMED board member Dave Cowger, a retired physician.

Fire companies like those in Claysburg and Warriors Mark quit providing QRS services — basic services provided by an Emergency Medical Responder — when they couldn’t meet requirements for 24-7 staffing and a medical director, as imposed by rules and regulations following revisions of the state EMS law several years ago, Watters told the board this week.

The new regulations set out licensing requirements, where before there had been voluntary qualifications, based on the honor system, Watters said.

Many small fire companies couldn’t meet the staffing requirements because the numbers of their QRS-qualified Emergency Medical Responders went too low to ensure round-the-clock coverage, Watters said.

They also couldn’t attract or afford medical directors, because the bill for their liability insurance to cover a fire company is about $9,000, Watters said.

The new rules also added insurance, equipment and reporting requirements, which contributed to making QRS too “cumbersome” for them to maintain, Watters said.

Watters’ workaround, which he’s been laboring on for a year and negotiating with the DOH for three months, calls for rural EMRs to work as subcontractors for AMED as needed on calls to their areas.

When a medical call comes in to the 911 center in a community like Claysburg, and an EMR is available to answer, he or she would do so under the aegis of AMED, which will always send an ambulance anyway to answer such a call, according to Watters.

AMED will provide the necessary supplies, although the fire companies will still need to provide liability insurance, which most already have, and workers compensation insurance, according to Watters.

There would be no monetary exchange, as there is no reimbursement from insurance payers for QRS calls, Watters said.

The setup will help the communities involved, because EMRs can often get to scenes significantly faster than AMED.

It also will benefit the fire companies, because it will restore their ability to provide QRS service, Watters said.

And it will help AMED, because not only will its patients get basic help quicker, there will be an extra person at those rural scenes to help care for and move patients when the ambulance arrives, he said.

The fire company EMRs also will provide a pool of potential applicants for work at AMED, said Watters, who has said it’s been difficult to recruit for EMS work in recent years.

A call to the area covered by the Claysburg Volunteer Fire Company can mean a trip as long as 13 miles for an AMED ambulance based in Roaring Spring, Watters said.

It could be half that far for a local EMR, Watters said.

In some cases, an EMR might live next door to the scene of an emergency, but be unable to help, according to Cowger.

EMRs can operate automated external defibrillators, perform cardiopulmonary resuscitation, clear airways and stop bleeding, according to Watters. An EMR certification is a step below that of Emergency Medical Technicians, whose certification is a step below that of a paramedic in the Emergency Medical Services field.

The DOH has actually expanded on Watters’ idea, clearing the way for the general sharing of staff not only between fire companies and ambulance services, but between ambulance services, according to Watters.

Cowger and others questioned the wisdom of the state’s adding the licensing requirements to the fire companies, given that it has led to turning partial coverage into zero coverage in some areas.

It’s better to provide service for 16 hours a day than none, Cowger said.

But the new workaround might ensure better care, after all, based on AMED’s involvement, which will ensure proper training of fire company EMRs and proper equipment, said board member Mario Wilfong.

One concern about the new arrangement is AMED’s potential liability for a subcontracted EMR crashing a vehicle on the way to an emergency scene.

There is no such concern with EMR performance at emergency scenes, because AMED isn’t liable, provided its equipment is certified and up-to-date and the EMR follows standard protocols, Watters said.

Fire company EMRs can take training in classes AMED already must provide for its employees, Watters added.

The proposed new arrangement could help even where AMED has substations, such as Bellwood, because it could mean extra assistance on calls and quicker assistance when the Bellwood ambulance is already on another call and the 911 center must send an ambulance from AMED’s Altoona station or its Tyrone substation, Watters said.

Solicitor Larry Clapper and AMED’s insurance carrier will review the proposed agreement with the Claysburg fire company, while the Claysburg company does likewise.